Tag: health insurance
About 20 new generic drugs will be on the market at the end of this year. The patents on the brand drugs have expired, allowing drug manufacturers to create generic versions. Most aren’t on the Medicare Plan Finder yet, and won’t be released until later in 2016.
Sometimes, companies will try to expand their patent, allowing for more time before a generic can be produced. Revenues for brand drugs drop dramatically when their generic versions are introduced. Generic drugs can take over 90% of a brand drug’s sales.
Here a few popular drugs that will soon have a generic version:
- Crestor – Rosuvastatin Calcium
Treats high cholesterol. Available in May. - Benicar – Olmesartan Medoxomil
Treats high blood pressure. Available in October. - Zetia – Ezetimibe
Treats high cholesterol. Available in December. - Proair HFA – Albuterol Sulfate
Treats asthma, COPD and others. Available in December. 
This image is from RxPreferred.com. Click on the image or link to see it enlarged
Fast Facts
- The price of generics is usually 80-85% less than brands.
- Once introduced, generics take about 90% of a brand’s sales.
- Generics must match the brand’s active ingredient, strength, type of medicine, effects, performance, and standards of testing.
- Generics can differ from brands in color and shape, label and packaging, and flavors and preservatives.
- There are two types of generics: Generic Equivalents, with the same active ingredients, and Generic Alternatives, with different active ingredients. Generic Alternatives are not prescribed as often, and require a separate prescription to be filled.
What is Telehealth?
Telehealth is using technology to communicate information and deliver health and health-related education services. It’s a broad term. Even if you aren’t especially tech-savvy, you’ve used telehealth if you’ve ever emailed your doctor or refilled a prescription online or over the phone. Video conferencing with your doctor to diagnose symptoms is an example of telehealth that isn’t widely used now, but could be in the future. Telehealth differs from telemedicine in their scope: telehealth is much wider, encompassing more aspects of health care.
There are four main “domains” of telehealth, from the Center for Connected Health Policy:
- Live Video: Real-time interaction between two parties: a provider and the recipient of health services.
- Store-and-Forward: A patient, using e-communication, shares a documented history of health, in videos or images, with a provider. The provider uses the documentation to deliver health services after evaluating it.
- Remote Patient Monitoring (RPM): A patient sends information to a provider using e-communication for status updates when the patient is released to their home or a care facility.
- Mobile Health (mHealth): Most often used to reach a broad audience by a healthcare organization or another group when promoting education or health practices. These are accessed through mobile phones and tablets.
The future is now
Last year, UnitedHealthcare announced that it would partially or completely cover video chats with doctors by 2016, though it’s not clear if their Medicare plans would be included. They believe virtual visits could be cheaper and easier than going to a doctor’s office.
Last month, a bipartisan group of U.S. Senators and Representatives introduced a bill that would “expand telehealth services through Medicare,” called the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act. The law would also “improve care outcomes, make it easier for patients to connect with their healthcare providers, and help cut costs for patients and providers.” So far, the bill has not been reviewed by committee. Currently, Medicare doesn’t cover all telehealth costs.
Have you gotten a vaccine recently? A new report shows that most Medicare plans don’t cover them.
Precription Drug Plans
No Prescription Drug Plans use a Vaccine Tier that would cover vaccinations, so most beneficiaries pay cost-sharing fees for vaccines.
- Average copay: $35 – $70
- Average coinsurance: 28% – 39%
- Actual out-of-pocket: $14 – $103
Medicare Advantage-Prescription Drug plans
A small amount of MAPD plans use a Vaccine Tier. in 2015, about 3% of MAPD plans had a Vaccine Tier. In 2012, it was about 2%. Among these plans, the Shingles shot, Zostavax, was the most often covered.
- Average copay: $42 – $54
- Average coinsurance: 16% – 27%
- Actual out-of-pocket: $10 – $72
Actual out-of-pocket prices were based on current costs for vaccines. If a beneficiary hasn’t reached they would pay the full cost of the vaccine, which can range from $38 – $276.
Why are the payments for beneficiaries have such a wide range?
The range of prices shows the rage of tiers that Prescription Drug and MAPD plans use for vaccines.
These are the vaccines listed above:
Boostrix: Booster shot- Tetanus, Diptheria, Whooping cough
Zostavax: Shingles
Varivax: Chicken Pox
Menomune: Meningitis
Havrix: Hepatitis A
VAQTA: Hepatitis A
Energix-B: Hepatitis B
RECOMBIVAX-HB: Hepatitis B
Twinrix: Hepatitis A & B
Tenivac: Booster shot- Tetanus, Diptheria
Tom Says:
“This is something we should all be telling our Congressmen: that all Medicare plans should have Vaccine Tiers to cover vaccinations.”
See the report by Avalere Health here.
For more, read a blog about the report on Modern Healthcare.
Last year, Medicare beneficiaries continued to save billions on prescription drugs since the 2010 introduction of the Affordable Care Act. These are the total savings:
- 10.7 million beneficiaries have saved $20.8 billion on prescriptions with discounts.
- Average savings per person: $1,945.
These are the numbers for 2015 alone:
- 5.2 million beneficiaries saved more than $5.4 billion with discounts.
- Average savings per person: $1,054.
The savings are 12% higher than in 2014, and twice as many beneficiaries saved money:
- 5.1 million beneficiaries saved $4.8 million with discounts.
- Average savings per person: $941.
Medicare beneficiaries are also being healthier by taking advantage of their plan resources.
- Nearly 40 million beneficiaries used “at least one preventative service with no copays or deductibles” last year.
- About 9 million Medicare Advantage beneficiaries, and 6 million with Medicare supplements, had an annual wellness visit last year.
Last year in Virginia, over 1 million people enrolled in Medicare Part B.
- 76.2% of beneficiaries in Virginia used Medicare Part B Free Services.
- 19.5% of beneficiaries in Virginia had an annual wellness visit.
Read the report on Medicare savings here.
For more on the numbers, see this Modern Healthcare article.
Difference can be hundreds of dollars
The formularies of Prescription Drug Plans show if, and how, the plan covers medications. A report by the Kaiser Family Foundation shows how the costs of on-formulary drugs differ between plans.
Generics
Of those listed, most generics’ highest cost will be $10, with the median cost hovering around $3-$5 dollars. Atorvastatin spans $0 to $20. Hydrocodone can cost up to $78- double the median cost of $36. Half of these drugs treat hypertension and high cholesterol.
This image is from the Kaiser Family Foundation.
Brands
The fluctuation in pricing is more severe with brand drugs. This list includes drugs that treat diabetes, asthma and other conditions. The highest cost of 60% of the top 10 brands is over $100. In the case of Spiriva, the highest cost is over ten times the lowest cost.
The most important questions when looking at drug costs are:
- Which tier is the drug in?
- What’s the cost to the customer per tier?
- Is the cost in copays (a flat cost for all drugs in a tier) or coinsurance (a percentage of the drug cost)?
Then costs are even higher. If your drugs aren’t covered, there are alternatives: using websites that compare drug prices and looking into Canadian pharmacies.
Current Advantage and Prescription Drug Plan customers are not affected
The Centers for Medicare and Medicaid Services brought sanctions against Cigna-Healthspring January 21.
Cigna-Healthspring cannot enroll new beneficiaries into its Medicare Advantage and Prescription Drug plans. They are also prevented from marketing efforts. Cigna supplement plans are not involved in the suspension. The sanctions will be removed when the problems are solved, which will be decided by Medicare.
Why?
The sanctions are a result of Cigna’s poor responses to customer complaints and appeals, and problems with the Part D formulary and benefits. These problems led to difficulty obtaining and denials of treatment and medications, and increased costs.
What about those in the plans?
Current members of Cigna-Healthspring Advantage and Prescription Drug Plans are not affected. Coverage will remain and the hope is that Cigna, under the oversight of Medicare, will solve the problems that led to the sanctions.
If you’ve experienced problems with your Cigna-Healthspring plan, file a complaint with them or with Medicare. Fill out the Medicare Complaint Form here, or learn more about complaints on Medicare.gov.
How long will this last?
The sanctions will be withdrawn when the problems are fixed. That could last as long as six months, a year, or possibly into 2017. Cigna must submit a plan to correct the issues to Medicare by January 29.
Here’s what to know before the snow comes this weekend
Chances are, you’ve heard the forecast for snow starting Friday. In case power is lost or you’re unable to travel, or if you’re just planning a trip to the grocery store before it hits, here are some tips to keep you safe and warm until the snow melts.
Foods.
- Water. You can buy bottled water, or fill bottles at home with water ahead of time. Generally, there should be enough for 1 gallon per person per day.
- Non-perishables. Some basic options are granola bars, trail mix, cereal, crackers, peanut butter and bread. Fruits and vegetables are good to have on hand, too.
- Some dairy products. Hard cheeses (Cheddar, Colby, etc.) are safe to keep un-refrigerated if they are wrapped and sealed. Yogurt can also be left out of the fridge for up to 8 hours. Since it’s so cold, even if power went out, these items would still be safe to eat.
- Pet Food. Don’t forget Fido! Be sure to have plenty of food on hand for your pet.
- Store hours:
- Kroger and Martin’s are open 6am-12am.
- Food Lion is open 7am-11pm (some close at 10pm).
- WalMart hours vary; some are open 24 hours and others are open 6am-12pm.
Items
- Medications. Enough to last you a few days if you won’t be able to get a refill.
- Blankets, hats, mittens and scarves. These will keep you warm if you must go outside, and if your power goes out inside. A good pair of winter shoes or snow boots will come in handy, too.
- Light. Keep flashlights, lanterns and candles within reach. Be sure to have a stock of extra batteries and matches.
- Heat source. A portable heater, firewood for your fireplace or a wood-burning stove are heat alternatives if you lose power.
- Non-clumping kitty litter. Sprinkling a bit of this in your path will prevent slipping when walking outside. You can use rock salt or sand for the same purpose.
Safety numbers
- Emergency contact numbers. Neighbors, or family and friends who live close by.
- Dominion: 1-866-DOM-HELP (1-866-366-4357)
- VEPCO: 804-224-8817
- Keep a cell phone charged!
So, you might be stuck inside all weekend. What is there to do? You’re already online, so here are some options:
- Watch movies or TV shows on Netflix.
- Read the news on the websites of USA Today, Time or The Washington Post.
- Play games on MSN.com or do puzzles at JigZone.com.
- Find new hobbies or craft ideas on Pinterest.
- Check out our new Twitter page! Follow us @MyMedicarePlann.
New tool shows the drugs with the highest costs for Parts B and D
Medicare has created an online dashboard to show which drugs have the highest spending among Part B and Part D plans.
In the interest of transparency, CMS aims to make public the trends surrounding drug spending by Medicare and Medicare beneficiaries. They hope to start a discussion about the costs of drugs and how they could be changed.
If a drug ranks high for spending, cost increase or cost to users, it was considered for the dashboard. Overall, the dashboard represents a large portion of total spending by Medicare. The Part D drugs show 33% of overall spending. The Part B drugs show 71%.
Below are three Part D charts and information on the drugs included. See Part B charts on the online dashboard (link below).
Trends in Medicare Part D Total Spendingfor the Top 5 Drugs in 2014.
- Abilify: treats schizophrenia, bipolar disorder, and others.
- Generic: Aripiprazole.
- Advair Diskus: treats asthma and COPD.
- Generic: None
- Crestor: treats high cholesterol and high levels of triglycerides.
- Generic: There is no generic version of Crestor, or Rosuvastatin Calcium. There are generic statin drugs, which are generic forms of other brand drugs, but no generic version of Rosuvastatin.
- Nexium: treats GERD.
- Generic: Esomeprazole Magnesium
- Sovaldi: treats hepatitis C.
- Generic: None
Annual Spending per User by Total Spending for Medicare Part D Drugs: 2014.
- Tracleer: treats pulmonary artery hypertension.
- Generic: None
- Gleevec: treats leukemia and other types of cancer.
- Generic: Sales of the generic imatinib mesylate will begin in February. The drug was approved in December.
- Olysio: treats hepatitis C.
- Generic: None
- Sovaldi: treats hepatitis C.
- Generic: None
- Copaxone: treats multiple sclerosis.
- Generic: Glatopa
- Humira: treats arthritis, Crohn’s disease, and others.
- Generic: Adalimumab
Medicare Part D Drugs with Large Increases in Cost per Unit, 2013 to 2014.
- Vimovo: PPI/ NSAID; treats arthritis, pain and other conditions.
- Generic: Esomeprazole/ Naproxen
- Captopril: ACE inhibitor; treats high blood pressure and kidney problems.
- Generic: Already generic
- Digoxin/ Digox: treats heart failure and heart rhythm disorders.
- Generic: Digoxin; (Digox is a brand drug)
- Prednisolone Acetate: treats eye conditions.
- Generic: Already generic
- Clobetasol Propionate: treats skin conditions.
- Generic: Already generic
To see the online dashboard, click here.
To learn more about the online dashboard, see this article from the Washington Post.
Change will save millions by preventing fraudulent claims
Prior authorization will now be necessary before Medicare will cover medical equipment such as wheelchairs and prosthetics. Prior authorization has always been required, but now it will be earlier in the process.
Why?
Fraudulent billing for these types of equipment costs Medicare millions. They expect to save big: $10 million in the first year, $200 million within five years and $580 million within ten years. In 2014, “the error rate among durable medical equipment billing was 53.1%, which accounted for $5 billion in improper payments that year.” Not all of those were intentionally fraudulent, but this new rule intends to correct many of those cases.
What is prior authorization?
Before an insurance company will cover something- a prescription or procedure- they will need to talk to your doctor and determine if they will cover it. If not, they could cover a substitute, change the dosage, or provide an alternative.
In this case, before Medicare will cover a piece of medical equipment, they will need to talk to your doctor earlier in the process than they previously had.
What equipment is affected?
The Master List of equipment that requires prior authorization includes items with “a high rate of fraud or unnecessary utilization.” They are also items that have an average purchase cost over $1,000 or an average rental cost over $100.
After 10 years, items are removed from the list. They will also be removed if the prices fall before then. In addition to wheelchairs and prosthetics, equipment like oxygen supplies, orthotics, and braces are listed.
Are there any concerns with this plan?
Some groups are concerned that the new rule will increase wait times for equipment that patients need ASAP.
To read the Centers for Medicare and Medicaid Services’ press release on the change, click here.
For more information on the prior authorization process, see this article from Healthcare Finance.
Approving new applications could significantly lower the cost of drugs
The question is how to reduce drug prices. The solution could be found in the Food and Drug Administration.
In recent months, politicians and organizations have written to the FDA, calling for the Office of Generic Drugs to reduce their overloaded system holding thousands of applications for new medications. Each of these 3,000 applications, called ANDAs (Abbreviated New Drug Applications), is a submission for a new generic drug.
Why is this important?
Generic drugs can cost up to 80% less than brand drugs. Of all prescriptions filled in the U.S., 86% are for generic drugs. Introducing new generics into the marketplace could increase competition and bring down prices across the board.
Is this a new problem?
The FDA will always have a backlog of new applications, says RAPS.org. The Office of Generic Drugs has been receiving more applications than it can feasibly look over.
However, other groups have noticed the problem getting worse. The Healthcare Supply Chain Association (HSCA) wrote in a letter to the FDA that approval time for generic drugs increased almost a full year from 2012 to 2014. They also said the Administration has approved fewer generic drugs each year for the last three years.
More generic drug applications are being submitted likely because so many patents are expiring. Drug patents originally issued in the 1980’s and 1990’s are nearing their end, opening up the opportunity for generic versions to exist.
Has anything been done?
In the last few months, the issue has gained traction. Senator David Vitter (R-LA) wrote a letter to the Acting Commissioner of the FDA urging the Administration to reduce the backlog of generic drug applications.
Democratic Presidential candidate Hillary Clinton also wrote to the FDA, calling for expediting pending applications and clearing the backlog.
For more on the FDA’s generic drug applications, see this article from the Wall Street Journal.
Click here to learn more about the FDA’s drug approval process.